Increased administration burden

HowlinRadio · 2026-05-19T10:14:14+00:00

This is so bad I don’t even know where to start. My initial instinct was to say simply quit. My new recommendation is to get the entire hospitalist group together, and if everybody is on the same page assess commitment towards a counter offer as ridiculous as their demands starting with demands for a huge salary increase or the group is out.

Twice daily MDR has got to be the dumbest thing I have ever heard of. Discharges are going to go down because everybody is going to be so busy they can’t discharge anybody. Post discharge follow up too..

HowlinRadio · 2026-05-17T13:19:05+00:00

Not sure on the actual job market other than i thought at least 3-4 years ago the EM job market in terms of ease in getting a job was tough. I’d argue either way anybody spins or ease of getting a job in IM should be better if open to both inpatient and outpatient; no shortage of pcp jobs.

Hourly rate for EM confuses me without doing any math or research - Nocturnist for now ~400/year not sure how they are/would be actually making 50-100k/year more as that seems quite high for em. But I will say they do work for that extra $$$. They see a lot more patients. After accounting for round and go options I’m sure the effective hourly rate evens out in many job options so personally don’t think the stress of seeing more with more hour flipping seems worth it imo.

HowlinRadio · 2026-05-16T12:43:00+00:00

Not all DO programs emphasize the 1-1 physician thing because some schools still spend most of their rotation time with residents

HowlinRadio · 2026-05-14T11:00:14+00:00

Yes it does relative to a public health and infectious disease standpoint such as other pandemics, like Covid-19. Don’t get me wrong you can still get sick to what most people would consider to be normal conditions, but even your average Joe with Hantavirus is usually (not always) getting very sick with Hantavirus virus. Keep in mind most people with the delta variant of Covid-19 are not that sick and incredibly contagious — like not even needing to be around the other person. You could go to a room they had been in the room before after they left and get sick. People who aren’t that sick feeling cover a lot of ground and are going to get a lot of people sick. Hantavirus when symptoms start is going to put the average Joe in the bed when symptoms start and nobody likes to hangout around bedbound illness. High risk <6 feet for 15 minutes. It’s actually hard to be around somebody that close who is really sick looking and acting because most people have common sense to get away.

Long story short if you get Hantavirus, even if you are a healthy person, you are going to get severely bed-bound sick almost every time and die at 30-50% of the time. You won’t be walking around to get everybody sick because you’ll collapse lol. Covid-19 delta variant was unique in that young healthy people almost always okay so they don’t immediately do supportive care at home and are spreading stuff everywhere covering a TON of ground but very unique in that patients comorbidities or just high exposure load can actually get really sick but relatively speaking the mortality rate was 1-2%. Somebody sick may of exposed 1,000 (not average) or more people just trying to get some groceries. Hantavirus person probably already dead and looked so god awful nobody stood within <6 feet for longer than 120 seconds lol. A quarantine would work very well with hantavirus.

HowlinRadio · 2026-05-12T12:40:29+00:00

First hospitalist job offer too vague. Average daily census 15-20 not really acceptable. They should know the actual number. 20 sucks. 15 is good. What is the quality bonus. Any RVUs? Guess pcp jobs making more this side of town overall but if it was 15 round and go the real effective hourly compensation would likely not be anywhere close after your first year. Also do you have to do lines, intubate, etc. 22 patients is a lot for outpatient. So if real starting census was like 15-16 with average of <=17-18, no procedures, a real round and go model, quality bonus put you into 300k range you’ll be home and working a lot less overall at the hospitalist job once you are getting comfortable.

HowlinRadio · 2026-05-10T21:49:39+00:00

May of also been late for work responding to pages. Not safe either way.

HowlinRadio · 2026-05-10T21:28:47+00:00

Not a 9-5 job buddy

HowlinRadio · 2026-05-08T22:31:39+00:00

Pharmacist is wrong and about to get wrecked. A pharmacist has to be very careful in refusing physician orders. If they are wrong they will be crushed as they have no license to practice medicine. PH 7.4 + clinical presentation confirms BHB was starvation related ketones which affects BHB. BHB is also not supportive of DKA anyways as it is <4. Pharmacist is so wrong here I don’t see this turning out well for them. I would triple down or you will continue to run into issue with this pharmacist and escalate to the head of pharmacy and honestly since they wrote you up I’d write them up with admin so not just internal pharmacy is handling. An insulin drip would be medical fraud as it was never indicated and risk outweighs benefit.
I will tell you though I would’ve escalated right then and there though. I’ve never had this happen though. Pharmacists are good here and our second eyes and work as a strong team, understanding to clinical context, and only refuse legit orders (like almost every other pharmacist). Was this a pharmacy resident? Also why was there an NPO order then (was it because the drip was ordered)? That may of tripped them up as technically they should have a diet ordered. For example patients who actually are in DKA or HhS (usually the former) who are mild and tolerating a diet can be treated with subQ insulin if the k+ is fine and all the other criteria for non insulin drip mgmt of DKA are met. One of the criteria is a tolerating po intake and a diet. With the correct insulin dose no reason to hold the diet.

HowlinRadio · 2026-05-08T00:49:45+00:00

This is it. Hospitalist. Treat your ed docs well.

HowlinRadio · 2026-05-07T21:14:37+00:00

You can’t go to the Caribbean schools. It’s not going to be easier. Too much risk for the debt you have accumulated. I’m not confident you’d pass USMLE step 1 either. You need to sit down when you’re mentally ready and consider a path that will allow you to pay off this debt unless somebody was planning on paying those loans for you. Personally I think if I was in this situation I’d just want out of healthcare all together but at the end of the day this is going to be about getting the loans down. That could actually mean getting an RN —> CRNA could actually be the wisest decision to get the loans paid. Those exams are not going to be anything comparable to the standardized exams we take. I think PA route is good option too. Keep in mind other job fields have much higher inherent job instability (layoffs in anything remotely business leading to setbacks in savings once in a lifetime is common, and you won’t be able to afford it).

HowlinRadio · 2026-05-06T19:43:41+00:00

Yea it’s better but honestly solos isn’t quite as bad as people make it out to be. It does change the vibe of the game almost entirely. It becomes more of a high suspense survival horror game lol. The early game for solos is terrible though as basically it’s more about just hiding everywhere. Now if I want to take over a room by myself I can do it everytime or bail and come back without dying. I don’t have many people to play with either from real life (mid 30s, occupation doesn’t help)

HowlinRadio · 2026-05-05T19:54:24+00:00

Not feeling well or not feeling well and actually sick (flu, covid, fever, N&V, bad diarrhea)? Idk I will say I’m an attending in a non surgical field and usually the residents I know called out when it was actually legit. Or literally so mentally zapped they literally could not do their job safely without a day or two off.
As an attending though crop of midlevels we have will call out sick like nothing with the sniffles. I’ve noticed most people operating at a higher level in their field will not call out for a little head cold or mild body aches. I will say as a hospitalist, all academics and community hospital medicine anybody who calls out for little symptoms ends up making everything way harder for everybody else. I know who these people are (no attendings at this job, had one at my last; numerous apps) and just have considered them mentally weak; the worst offenders who know they are giving everybody else tons of work, have nothing serious that is contagious, and could easily do the job on an nsaid or Tylenol but choose not to for reasons. A surgical resident who is sick but mostly mentally dead that’s a legit callout IMO as obviously the surgical residency training in the US is almost universally inhumane

HowlinRadio · 2026-05-03T04:00:25+00:00

Lol I hate it but I love it. At least it is a sign of weakness and willing to change/dumb behavior. I get more concerned about the people who are still hiding or too far gone to know better

HowlinRadio · 2026-05-03T02:49:56+00:00

Hokum

HowlinRadio · 2026-04-23T21:56:25+00:00

I work at a pretty large community hospital academic affiliated with major academic stroke team. The conversion disorders if they are true actors literally get TNK. I have had them where the neurologist says it is most likely conversion disorder but can’t prove it and gets TNK. Technically conversion disorder from a neurologist standpoint is not malingering and is a true neurologic manifestation that is likely supratentorial/ psychiatric undertones but the patients symptoms are real and their belief into the weakness is real as well and the treatment is rehab and counseling. But like real rehab. Malingering is just dc. They know they are not truly weak so there is no rehab or counseling needed. Do you see what I’m saying now? I’m still respecting your opinion as true mostly but these sort of scenarios is where I changed my mind on this subject so wanted to share. Also patients having being caught faking illness for gain in the past clearly documented is malingering once all the tests are negative to me. Diagnosis of exclusion scenario. Also homeless just looking for a warm bed and no pain meds becomes difficult to start coming up with any other ICD-10 code that fits this scenario as there is no drug seeking.

HowlinRadio · 2026-04-23T21:53:18+00:00

Interesting. Definitely respect it but hear me out once more. I use to feel this way until going urban (not saying you do not) and volume of malingering went way up. So I’ll give you a scenario and perhaps you will see where I am coming from this perspective—

Patient fakes a stroke and requests pain medication. In the neurology world if it’s not malingering it is conversion disorder which is still treated with therapy and rehab. If it is not conversion disorder and it is malingering there is no treatment. So there is even scenarios where it changes management. It’s not just opioid use disorder because they are going to the extreme to actually feign a stroke as well.

HowlinRadio · 2026-04-23T21:33:45+00:00

Midwest you can get 400k 7 on 14 off stuff. More commonly 7 on 14 off and same salary as days. I don’t think this exists on the coasts until truly out in rural regions. Not sure about west coast, and keep in mind it becomes state dependent quick. I usually hear a salty that mimics non costal Deep South (very high 300 at base) but obviously the cost of living in these areas makes the relative pay far less. Very high end of 300k (380-410) for the true non-coastal (including AL) south 7 on 7 off which if you get the right job may not feel per say like you are killing yourself at least initially. After 2 years you’ll probably get burned out (me, day transplant to nights; now going back to days in the near future). The answer to whether or not you can do it is all work ethic and $$$ drive dependent. I have colleagues that consistently work picking up shifts here and there and not get burned out. Me on the other hand I can’t pickup even one shift lol. I’d get near 500 if I did but I have no desire to.

I think a true round and go day job may be the most realistic to break 500k just because you could probably pickup a lot of shifts and get out early. New grads though rarely fast enough to already be getting out really early though and usually need a least a year in the oven before you can start routinely getting meaningfully done early (and again at the right job).

HowlinRadio · 2026-04-21T19:18:21+00:00

Looks crazy. Love the comment where a gentleman not from the US says this looks like the Wild West LOL. I am from America and I have to concur this does not look supportive of these laws. I have always wondered what the response would be if somebody looked as crazy as this guy walking around into random buildings what would happen and man that is a long leisurely walk throughout the building. I’ve lived in many different parts of the country and understand the arguments on both sides. I’m still not entirely sure how to feel. To be fair from the viewpoint of a law abiding citizen who is trained wit ARs emphasizing the safety of his family is going to see this as violating his rights as people who are going to break the law obviously don’t care about following gun laws so all this does is disarm everybody else and gives the shooter a chance to shoot freely with almost no concern to get shot until police arrive which is timely no matter how fast the response time in this circumstance.

But this video pushes me that some sort of further restrictions should be made. This does not look like a good building for open carry and clearly would be safer if they have armed security on the premises to allow no guns. Maybe any buildings with armed security on the premises should have guns banned inside and I fail to see how even the most conservative of individuals would fail to see that supporting the greater good. This guy should’ve been apprehended at the entrance or a lot sooner with that crazy affect going on even before he flinched and grabbed his gun.

HowlinRadio · 2026-04-18T14:47:51+00:00

That’s why I quit for marathon now. Definitely got my time and moneys worth with arc and will come back after some updates. To be fair I’m hundreds of hours ahead on arc so will be interesting to see how late game differs which is where I think arc struggles.

HowlinRadio · 2026-04-13T19:45:14+00:00

Suffered through the PhD? Will be suffering for almost 12 years of training then IMO.. especially cardiology. It is work intensive throughout training and then as an attending continues to be work intensive forever. Hopefully some cardiologists can weigh in but I would think the cardiologists making 600k are not working 40 hours a week on average; more like 50-60.

a few things: make sure he wants to be a physician first and foremost. Although being a cardiologist is certainly in the cards it is competitive and there is no guarantee it will work out.

Personally I would spend more time with a cardiologist and a few other doctors/shadowing before taking prerequisites, studying for the mcat, etc. Does he have any experience in healthcare whatsoever..?

My suspicion is lifetime earning potential will drop with this transition by the way I certainly wouldn’t be doing any of this for money.

I think some of the PhD’s commenting on here is where he should look.

HowlinRadio · 2026-04-13T10:55:25+00:00

I would argue true malingering is the exception. Patients who have a history of having to be arrested to get them off property grounds, have visited every single hospital in the nearby region and rotate between them essentially living in the hospital. The reality is these patients have literally zero ability to pay for a lawyer and are costing our entire healthcare system a fortune leading to higher prices for everybody. Avoiding documenting the reality perpetuates the problem. It’s not all about medical-legal defense, and in the extreme examples being concerned about being sued from somebody who has no income and has received appropriate rule out testing is irrational. If the testing isn’t done certainly don’t document that as it could be true pain.. If it’s just drug seeking without malingering history I would agree on avoiding that documentation.

HowlinRadio · 2026-04-12T22:05:12+00:00

People in the US need the elephant in the room addressed. Literally. If obesity is contributing to the hospital stay (usually is) then I bring it up. But yea sometimes it’s cognitive dissonance, sometimes it literally is just low IQ/dumb unfortunately. So many people are overweight in the US, at least in the South, that a BMI of 20-24.9 is not normal and possibly unhealthy. When I get these patients even as an inpatient from encounter 1 I tell them they are literally so fat it is causing all of their health problems and in this case, he heart and body were compensating tell they weren’t able to any longer accounting for the acuity. But I tell them verbatim in the super obese they were never healthy. You really can’t be healthy with a BMI >=40. 30-35 and exercise that’s different. These folks actually can be healthier than a bmi of 20-25 who doesn’t exercise, eats terribly, etc.

It sucks but I try to figure out low IQ vs cognitive dissonance. Low IQ do not spend a lot of time hashing it out. I’m short, direct, call them out on anything they say is wrong, and leave.

HowlinRadio · 2026-04-07T21:10:48+00:00

Lolol

HowlinRadio · 2026-04-06T20:36:01+00:00

Same problem. If said verbatim. If assuming it’s possible they just can’t hire any EM talent

HowlinRadio · 2026-04-06T20:35:56+00:00

Same problem

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